Cutaneous reactions after CoronaVac and BioNTech vaccines

Dear Editor, The first COVID19 vaccine to humans worldwide was administered in the UK on December 20, 2020 (BioNTech). In our country, vaccination started on January 13, 2021 (CoronaVac). As the vaccination rate increases worldwide, cutaneous reactions such as local injection site reactions, urticaria, cutaneous eruptions, herpes simplex, herpes zoster, pernio, and reactions related to cosmetic filler injections are reported.1– 3


Dear Editor,
The first COVID-19 vaccine to humans worldwide was administered in the UK on December 20, 2020 (BioNTech). In our country, vaccination started on January 13, 2021 (CoronaVac). As the vaccination rate increases worldwide, cutaneous reactions such as local injection site reactions, urticaria, cutaneous eruptions, herpes simplex, herpes zoster, pernio, and reactions related to cosmetic filler injections are reported. [1][2][3] We present nine patients who applied to our dermatology outpatient clinic because of skin rash within 15 days after being vaccinated with CoronaVac or BioNTech between April 2021 and July 2021 and did not have a chronic disease or drug use history other than vaccination in the last month. (Written informed consent from the patients for the use of images and publication of their details were obtained.) The average age of the six male and three female patients who applied with a complaint of skin rash following vaccination was 38.3 years. The mean time to appearance of the rash was four days.
Five patients applied with the cutaneous reaction after the BioNTech and four after the CoronaVac ( Table 1) Seven hundred eighty healthcare workers from Turkey were evaluated four weeks after vaccination with CoronaVac, and only 2.3% of them developed cutaneous side effects (1.5% cutaneous eruption, 0.8% urticaria). It was stated that the most common sites of involvement were the trunk (42%) and the face (36%), and females were more frequently affected than males. 2 Similarly, in another study evaluating the cutaneous side effects of CoronaVac, it was stated that females were affected more frequently. 5 On the contrary, in our patients, the female: male ratio was 1:2.   One of the cutaneous reactions reported due to COVID-19 vaccines is herpes virus infections. Catala et al. 6 have suggested that COVID-19 vaccines are associated with the reactivation of herpes viruses and the possible mechanism is that a strong specific immune response against the S protein from vaccines disrupts cell-mediated control of these latent viruses. Varicella-Zoster Virus reactivation was mainly associated with BioNTech, and men were more affected than women. It has also been said that Herpesvirus 6 and 7 reactivation is associated with pityriasis rosea-like eruption. 6 Our cases of herpes simplex and pityriasis rosea-like eruption occurred in male patients following the first dose of BioNTech, whereas one female patient suffered herpes zoster following the third dose of CoronaVac.

TA B L E 1 Patients with cutaneous reactions after vaccination
COVID-19 vaccine hesitancy is a critical problem that hinders the adequate immunity of the population with vaccines. Informing physicians about vaccine-related cutaneous reactions and reassuring and encouraging patients to take the next dose by suggesting the necessary medical treatments will contribute to the smoother progress of vaccination programs.

I N FO R M ED CO N S ENT
Written informed consent from the patients for the use of images and publication of their details were obtained.

CO N FLI C T O F I NTE R E S T
Both authors declared no conflict of interest.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.

E TH I C A L A PPROVA L
Authors declare human ethics approval was not needed for this study.